Severe head injuries that fracture the temporal bone often devastate hearing permanently, leaving patients with profound deafness that conventional hearing aids cannot address. This comprehensive analysis of surgical outcomes reveals that cochlear implants can restore meaningful hearing function in these challenging cases, provided the auditory nerve remains intact despite the trauma. The systematic review examined 11 studies tracking patients who received cochlear implants following temporal bone fractures, a notoriously difficult clinical scenario due to disrupted anatomy and potential nerve damage. Results demonstrated that successful auditory rehabilitation depends critically on two factors: preserved cochlear nerve integrity and surgical timing within the first year after injury. High-resolution CT scans proved essential for evaluating fracture patterns and cochlear accessibility, while MRI imaging and promontory testing became crucial diagnostic tools for assessing whether the auditory nerve survived the initial trauma. The research reveals a narrow therapeutic window where cochlear implantation achieves optimal results. Surgery performed within 12 months of the original fracture consistently produced superior outcomes compared to delayed intervention, primarily because prompt treatment prevents progressive scarring and bone formation that can complicate device placement and function. This temporal constraint represents a significant clinical insight, suggesting that trauma centers should expedite cochlear implant evaluations rather than waiting for complete healing. The findings challenge traditional approaches that favored extended observation periods, instead supporting aggressive early intervention when imaging confirms viable neural pathways despite extensive bone trauma.